Journal of Urgent Care Medicine

Will New CMS Program Boost Medicare Quality Bonuses?

The Centers for Medicare and Medicaid Services (CMS) calls it a brand-new platform, while skeptics are saying it’s just the same-old structure with a fresh coat of paint. Either way, CMS is rolling out the Quality Payment Program, which it says will ease documentation requirements for physicians while also providing new opportunities to earn bonuses by providing quality care. Under the program, physicians can receive Medicare reimbursement by participating in either the Merit-Based Incentive Payment …

‘Rampant’ Medicare Overbilling Highlights Need for Cost-Efficient Care

Medicare was overbilled by 12.1% in 2015, thanks to improper fee-for-service reimbursements in 21 states, according to the Centers for Medicare & Medicaid Services (CMS). That’s up from 8.6% just five years ago, making it one of the highest error rates in history. Louisiana was the worst offender, with an overbilling average of 19.4%—equating to over $1.2 billion in excess fees. Texas and Georgia also showed over a billion dollars in overcharges to Medicare last …

Prosecutors Vigilant to Questionable Medicare Bonuses

A settlement with a billing company in Massachusetts is just the latest outcome of federal prosecutors going after healthcare companies for return of Medicare bonuses claimed in error. It’s a reminder that filing for claims improperly—even if inadvertently—can have serious consequences for operators. In this case, Medical Reimbursement Systems Inc. has agreed to pay $500,000 to settle allegations that it submitted false claims to the military’s Tricare program on behalf of a medical practice in …

Uncle Sam Picks Up Two-Thirds of the Healthcare Check

Even as private citizens continue to pay a greater percentage of their paychecks for healthcare, new data say that the government is picking up the biggest portion of healthcare spending overall—64.3% as of 2013. Of particular note, Medicare spending rose about 2.5% between 1999 and 2013. The data, which are published online in the American Journal of Public Health, reflect direct government payments for Medicare, Medicaid, and other public programs (eg, the Veterans Health Administration, …

Think Tank Says Aetna–Humana Deal Would Make Seniors Pay More

The Center for American Progress (CAP), a Washington, DC-based think tank, says senior citizens will be forced to pay higher Medicare Advantage premiums if Aetna’s proposed acquisition of Humana goes through. Aetna currently holds 7% of that market and Humana 19%. While their combined share of the entire current Medicare market would still be just 8%, Anthem has also moved to buy Cigna Corp. The combined effect of such deals could cut competition and result …

Dark Days for the Affordable Care Act

The United States Senate is the latest—and certainly the most prestigious—body to recommend pulling the plug on the Affordable Care Act (ACA, also known as Obamacare). The Senate followed the lead of the House of Representatives by passing a new bill on December 3 that essentially repeals ACA. Passage of the new bill may be a moot point, as President Obama is likely to veto it. Once heralded by proponents as the salvation of uninsured …

Will Medicare Change Make Urgent Care More Appealing?

The end of 2015 means the end of a 10 percent bonus paid to primary care physicians who care for Medicare patients. Depending on how they react, some practices could see more patients turn to urgent care for acute complaints. Essentially, primary care practices will have three options once their bonus disappears: eat the revenue loss, take in more patients to make up for it, or charge patients more. The bonus program was initiated in …

States Grapple with Their Own Regulatory Approach to Urgent Care

URGENT MESSAGE: Urgent care centers are subject to myriad oversight by individual states, accrediting bodies, Medicare/Medicaid, and private insurance companies. Still, the patchwork nature of state regulatory and legislative trends impacting urgent care in 2015 raises questions—and expectations—for what might be coming next year. Alan A. Ayers, MBA, MAcc is Practice Management Editor of The Journal of Urgent Care Medicine, a member of the Board of Directors of the Urgent Care Association, and Vice President …

Revenue Per Patient, Prescription Drug Management for MDM, Medicare and HCPCS J3301 Denials

Q. What is an acceptable income per patient visit for an urgent care clinic? A. The recent benchmarking survey completed by the Urgent Care Association (UCA) found that the average urgent care center collects $110 per patient. However, the “acceptable” net revenue per patient visit varies widely from center to center and state to state. It fluctuates based on many variables: Existing contracts from payors State (e.g., payors in California and Arizona typically have lower …